Failure to look for improbable causes of familiar ailments can have tragic
consequences

The many pitfalls in medicine include overlooking the rarer causes of a common condition, such as the (very) common irregular disturbance of heart rhythm known as atrial fibrillation (AF). This affects, it is estimated, one in four of those over the age of 70, being due mainly to the ubiquitous age-related narrowing of the blood vessels to the heart.

This would certainly be the probable explanation for a reader who, three years ago, had a combined aortic valve replacement and bypass operation, complicated by several subsequent admissions to her local hospital with uncontrolled, rapid AF. The main hazard of this condition, as we all know, is that it increases the risk of a stroke – hence the need to take blood-thinning drugs.

None the less, in December last year she suffered a stroke, paralysing her left side and confining her to a wheelchair. She has, it now turns out, an overactive thyroid, the underlying cause in approximately one in 100 of those with AF, easily diagnosed with a simple blood test. And, of course, eminently treatable.

Dubious practices

There have regrettably been several further instances of the devious methods, featured recently in this column, by which some family doctors seek to boost their income – including the unsolicited phone call asking patients to “drop in” to the surgery for a blood pressure check.

This is no sooner done before the unwary patient is ambushed with a series of cognitive tests: asked to draw a clock face on a sheet of paper; recite numbers backwards; recall a random name and address, and so on.

“I felt I was being treated like some ignoramus, solely to bolster the practice’s quota for dementia screening,” writes a gentleman in his eighties.

He was sufficiently incensed to write a strong letter of complaint to the senior doctor in the practice, but did not send it, fearful that “rubbing him up the wrong way might make things difficult for me in the future when I need their help”.

Next, a “fit, tall, lean” reader in his mid-seventies reports that, despite passing his health check-up with flying colours, he was none the less advised it would be in his interests to take cholesterol-lowering statins for the rest of his life.

Over the following few months, he gradually sunk into what he describes as “general decrepitude and ennui” until, reading of their side-effects, he decided to give them a rest. “Within a week I was, and remain, in a state of vibrating high-level wellness,” he writes.

Poor taste

This week’s medical query comes courtesy of Mr AN from Aberdeen, whose culinary efforts cooking the family supper are marred several times a week by a transient loss of the sense of taste. “It only happens when I cook, never at any other time,” he writes, “and returns to normal about an hour after enjoying the (tasteless) fruits of my labour.”

Meanwhile, on a related theme, a keen oenophile, who has always “hugely enjoyed” drinking red, rose and white wine and port, is dismayed to discover that all red wine now tastes disgusting, though curiously he can still apparently appreciate their bouquet – “which makes them doubly enticing”. He has some delicious reds laid down and is apprehensive that he will not regain his taste for them until they are past their best.

The last drop

Finally, the suggestion that those troubled by recurrent cystitis should, to ensure the bladder is completely empty, “wait and try again”, has prompted the observation that some gentle nose blowing or light coughing when urination has almost finished helps “expel the last drops”.

Two further tips that may be useful are to rock the pelvis back and fro half a dozen times when sitting on the lavatory, and (commended by a nursing sister from Lincoln) that tickling the base of the spine causes the bladder to contract, thus “discharging the final stream”.